Parents of premature babies also have to leave their regular the very first relationship between parents and their baby (DeMier et al., ;. Several studies on premature infants and their parents focused primarily on that can have a negative impact on their relationship with the child (Feldman and . Parents may love their newborn baby deeply and passionately, but often not . still is controversy about the effect of prematurity on the parent-infant relationship, .
A correlation between negative conditions at birth e. Neonatal Intensive Care Unit may be a stressful place both for mothers and fathers.
Mothers and Fathers in NICU: The Impact of Preterm Birth on Parental Distress
It might be useful to plan, as soon as possible, interventions to help parents through the experience of the premature birth of their child and to begin an immediately adaptive mode of care. Preterm birth is a multi-problematic event that presents two main consequences: Although it has been widely demonstrated that preterm infants are at risk for developing deficit and delays, the underlying causes of these poorer developmental outcome, and the role of parents, are still less understood.
Sameroff and Chandler proposed a transactional model that described that children and parents influence each other. This model predicts that preterm birth itself does not cause negative developmental outcomes alone but that the stressful conditions following early delivery moderates the risk for later developmental difficulties.
One month after preterm birth, parents are shocked by the physiological and psychological conditions of their baby Hoffenkamp et al. The event could interfere with their transitions into parenthood: Referring also to the eight criteria for defining a potentially traumatic event, identified by Greenpremature birth could be a traumatic event since it is a threat to the physical integrity of the mother and a threat to the integrity of a loved one, the baby.
These findings are particularly important since a recent study pointed out that although the majority of units in different European countries reported a NICU policy that encourage both parents to take part in the care of their babies, parental involvement as well as the role played by mothers and fathers are generally more limited in Italy.
Tasks involving more responsibility such as supporting the baby during uncomfortable procedures were commonly allowed in Sweden, United Kingdom and the Netherlands, but less in Italy.
Managing relationships after premature birth
In parents of preterm infants also external infant characteristics, associated with immaturity and severity of medical status, could be stressors that could further impair the very first relationship between parents and their baby DeMier et al. The appearance of preterm babies is perceived as less physically attractive than the features of full-terms: In order to make this transition, fathers and mothers have to perform different roles and develop specific competences.
Different studies showed that after premature birth fathers usually have a supportive role. Only after the discharge of their babies do fathers seem to be safer and more confident trying to establish a new active relationship with infants Jackson et al. However, empirical research on parents of preterm infants has demonstrated that the premature birth and the subsequent admission to NICU are stressful experiences significantly different from that of parents of full term infants Goldberg and DiVitto, Preterm birth can be considered a traumatic event that involves child and parents Tracey, Several studies on premature infants and their parents focused primarily on mothers, but recent research, that included fathers, suggest that both parents are emotionally involved Matricardi et al.
Considering the point of view of the father he may feel that he has to deal with the emotional aspects connected to his paternal role as well as with the need to play a supportive role in relation to his partner. For fathers, the preterm delivery and the visits to the NICU, where the baby often stays for a long time, may constitute a stressful experience, accompanied with fear and sense of impotence Lundqvist and Jakobsson, ; Alderson et al.
In fact the premature birth and the consequent hospitalization of the newborn are moments of great importance with regard to the risk of postpartum depression in both parents: More recent research confirmed that paternal depression may affect the relationship between the mother and her baby Ramchandani et al. As the need to explore, also from a qualitative point of view, the impact of the preterm birth on both parents is increasingly clear, it is important the use of appropriate tools such as interviews to investigate parental perceptions, feelings, thoughts, and worries.
In a recent qualitative study Hugill et al. Their narratives have highlighted, moreover, the intense interior distress they encountered. They had often tried to react by hiding their emotions behind stereotypical behaviors in order to protect themselves from further pain. The authors underline the clinical utility of the CLIP: Using this instrument Keren et al.
This study showed that the CLIP was a useful clinical tool and a predictor of early disruptions in the mother—infant relationship at the nursery. More recently two studies referred to this instrument. In the first, Tooten et al.
In line with literature, this study highlighted that parents of term infants had more positive experiences and perceptions of their newborns than parents of preterm infants; besides no significant differences were found between the emotional experience of mothers and that of fathers.
In the second, Rossman et al. The growing interest toward this interview, that seems to be confirmed by its increasing use, led us to realize a research aimed at adapting the CLIP to the Italian context and exploring its possible connections with aspects as depression and anxietyvery relevant in parents of premature infants. The first objective was to evaluate levels of anxiety and depression in both parents, also detecting the possible presence of significant differences between them.
A subsequent purpose was to explore the presence of correlations among the CLIP and levels of anxiety and depression in fathers during hospital stay. Participants All the consecutive parents whose child was hospitalized immediately after preterm delivery at the NICU of the Chieti University Hospital Italy between July and September were invited to take part to the study.
Less fathers than mothers accepted to take part to the study since males were spending a very few time in the NICU because of their job commitments. In the present paper, we have only considered those parents who decided to participate in the research as couples.
All the children were born before the 37th week of gestation, were unaffected by genetic illnesses, neonatal deformities, or neurological damages clinically identifiable at birth. After being informed of the aims of the research project and after having signed the informed consent, every parent individually filled in a socio-demographic questionnaire, followed by two self-report instruments, i.
All the tools were administered by a trained clinical psychologist between 10 and 20 days after childbirth. We chose this period for administration of both questionnaires and interview on the basis of the consideration that several days had passed from delivery and both mothers also those who had a urgent cesarean delivery and fathers have had the opportunity to approach the newborns and develop the first interactions with them.
The total score can range from 0 to In this study we have used the Italian version validated by Pedrabissi and Santinelloi. Its semi-structured nature offers the clinician a twofold advantage: The CLIP, that requires about one hour to complete, analyzes eight main areas: Through an exploratory factor analysis, they identified two factors that were termed Readiness for Parenthood and Parental Rejection.
On the basis of the original interview, we translated and adapted the CLIP to the Italian context through the method of the back-translation Brislin, One bilingual translator blindly translated the CLIP from the English language into Italian, and another bilingual back-translated it to English.
Differences in the original and the back-translated versions were discussed and resolved by joint agreement of both translators. In this research project, we referred to the coding system developed by Keren et al. Statistical Analyses All statistical analyses carried out with the Statistical Software for Social Sciences, SPSS, version 19 were conducted on raw scores, because these data reflect the real individual responses.
The use of other type of data, for example data estimate, could modify results, since they could determine several differences at the individual level because there are many types of estimates methods.
Moreover for each data estimates error variances should be computed. Checking for the factorial structure of the CLIP in an Italian sample, we carried out an exploratory factor analysis following the Keren et al. Results The final sample consisted of 64 subjects, i.
Mothers and Fathers in NICU: The Impact of Preterm Birth on Parental Distress
Characteristics of fathers, mothers, and infants. According to the birth weight, In order to check for significant differences between parents with respect to depressive and anxiety symptoms we conducted an ANOVA.
Mean and standard deviation for each parent and the F-values for differences between the two groups are reported in Table 2. As we can see mothers showed a higher level of depressive and anxiety symptoms than fathers.
The effects of premature birth on parents and their relationship.
All differences were statistically significant. As far as depressive symptoms, we divided the sample into two groups according to EPDS cut-off. We found that No significant differences emerged between the two groups of fathers. With regard to anxiety symptoms, we divided the sample according to the score thresholds suggested in the Italian manual Pedrabissi and Santinello, of the two forms of the STAI.
Most of the mothers and fathers showed an intermediate level, while a clinically significant state anxiety was found in The contribution of individual cells to association was examined through adjusted standardized residual. Mothers and fathers were significantly different both in the low and intermediate categories of state anxiety but not in the high category.
Also for Trait Anxiety Figure 2the majority of both males and females were placed in an intermediate level while the percentage of subjects with a high level of symptoms was low. Mothers and fathers differed in the low and high categories of trait anxiety, but not in the intermediate category. As mentioned above, the CLIP is a relatively new tool in the Italian research context, so, first of all, we aimed to test its factorial structure. We carried out an exploratory factor analysis with principal component method and Varimax rotation.
We would evaluate if the two factors Readiness for Parenthood and Parental Rejection found by Keren et al. This percentage is comparable with that found by Keren et al.
Most of the items showed unique loadings on one factor, with the exception of three of them: Most of the items loaded on Keren et al. Unexpectedly two more items loaded on this factor: